The quest for clear and blemish-free skin is all the rage lately. New skin care regimens, dermatological procedures, and cosmetic formulations emerge frequently. However, the conversation usually focuses on more common skin issues such as acne and skin lightening. Conversation revolving around problems like melasma pales in comparison to these topics.

A Deeper Look into Melasma

Melasma is a form of hyperpigmentation disorder characterized by light to dark brown patches on the face, typically on the forehead, cheeks, upper lip, and chin areas. Sometimes, it can also appear in the neck, arms, and upper back.

Melasma more commonly affects women, especially those who live in locations with intense sun exposure. Pregnant women and darker-skinned individuals are at a higher risk of melasma. The development of melasma is complex. The exact cause remains unknown, but several triggering factors have been identified and studied. These factors are involved in different pathways that lead to hyperpigmented patches on the skin.

Understanding what factors affect and trigger melasma is vital to choosing treatment regimens. Factors that contribute to melasma include the following:

● Genetic component - Although not hereditary, evidence has shown that genetics play a part in the development of melasma. People with relatives who have melasma are at a higher risk.

● Ultraviolet (UV) radiation - Melasma is more common in people exposed to intense direct sunlight.

● Visible radiation/Blue light - Visible blue light irradiation stimulates Opsin-3 receptors, which directly affect melanin production.

● Hormone alterations - Changes in hormone levels caused by pregnancy and oral contraceptives contribute to melasma development.

● Oxidative stress - Oxidative stress has been found to affect the development of melasma directly.

● Other factors include the use of drugs that increase skin sensitivity to light, environmental factors such as air pollution, and the use of cosmetics such as peeling agents.

Melasma and Its Deep Implications

Despite melasma being not life-threatening or a sign of a more severe condition, its adverse effects are wide-ranging. It dramatically impacts the quality of life and the emotional, social, and mental well-being of people suffering from it. People with melasma suffer from psychological devastation and diminished self-confidence. They also often feel bothered, frustrated, and depressed because of their skin appearance.

Letting the Light In: Treatments for Melasma

The complex origin and development of melasma make it harder to treat than other skin issues, thus, requiring a multimodal approach.

1. UV Protection

UV protection is the cornerstone of melasma treatment. Avoiding direct sun exposure and using sunblock containing iron oxide is encouraged. Sunscreens with iron oxide do not only block UV light from the sun but also protect from visible radiation/blue light.

2. Topical Treatments

There are many topical treatments for melasma; however, data for most are limited.

● Hydroquinone - Hydroquinone is considered the gold standard for treating melasma. However, its use is limited because of its adverse effects, including ochronosis (dark brown/ochre-colored deposits in the skin) which is rare but severe. It is also contraindicated in pregnant women due to its possible adverse effects on the fetus.

● Topical Tranexamic Acid - Tranexamic acid provides a significant effect in treating melasma. It has a comparable effect to hydroquinone and is generally more well-tolerated.

● Retinoids - Retinoids like tretinoin and azelaic acid work by speeding up the skin's cell turnover. Simply put, it produces a peeling effect so that newer skin can come to the surface. They are usually used in combination with hydroquinone, but their use is also limited by side effects like irritation, dermatitis, and a burning feeling of the skin.

3. Oral/Systemic

Oral treatments for melasma are also available. They include antioxidants, tranexamic acid, and procyanidin.

● Tranexamic acid - The use of oral tranexamic acid for melasma is considered “off-label.” It means that the drug is intended to treat bleeding disorders, but it has also been shown to reduce melasma patches' appearance. It has demonstrated promising efficacy for melasma but needs to be taken with medical supervision since it can cause severe side effects like deep vein thrombosis.

● Antioxidants - Antioxidants are another class that is widely studied for melasma. As mentioned above, oxidative stress is one of the triggering factors of melasma. Oxidative stress occurs when there are more free radicals in the body than antioxidants. These free radicals can cause a chain reaction and

damage the cells in the body. Antioxidants like vitamins C and E and carotenoids help scavenge these free radicals to prevent their harmful effects.

● Procyanidin

Procyanidin has antioxidant and anti-inflammatory properties making it a promising option for treating melasma. It is several times more potent than vitamin C and E as antioxidants. It can also recycle vitamin C and regenerate vitamin E. On top of that, it can protect natural antioxidants in the body from oxidative stress.

Finding the treatments mentioned above in the Philippines is easy. However, only one FDA-approved and commercially available treatment has Procyanidin. Pynocare is an innovative formulation of procyanidin, vitamins A, C, and E that works synergistically to target melasma.

Pynocare is clinically proven and tested to reduce the appearance of melasma patches in as fast as 8 weeks. Studies have shown that it produces the best result when taken twice daily for 8 to 12 weeks with little to no side effects.

As mentioned, procyanidin is a potent antioxidant. Its vitamin C content inhibits the formation of melanin and converts dark and oxidized pigments into lighter and reduced ones. In addition, vitamin E eliminates peroxide levels in the body, a form of free radical. Vitamin A completes the equation by enhancing vitamin C and E antioxidant power.

The most challenging part of treating melasma is its high possibility of recurrence. With Pynocare, that is not a worry since it can be taken as a preventive measure for people at risk of developing melasma.